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Examples of Medicare fraud

Medicare fraud is quite a common occurrence in Tennessee and throughout the country. This can put patients' health at risk, and it also costs taxpayers a lot of money. Many different parties can commit this type of fraud and, if caught, the penalties can be severe.

According to California Health Advocates, Medicare fraud can happen in a number of ways. The parties who commit fraud include healthcare providers, insurance brokers, equipment suppliers, pharmacists, companies and beneficiaries. Some examples of how fraud occurs include:

  • Provider bills for unnecessary services or services that did not occur
  • Brokers make unsolicited home visits or phone calls
  • Suppliers bill for different equipment than what the beneficiary got
  • Pharmacists fill a script with an expired drug
  • Beneficiaries let someone else use their Medicare number
  • Companies offer bribes to providers to prescribe a particular medication 

To help protect consumers, Medicare outlines a number of rules and regulations that Medicare providers and suppliers must follow. Anytime they do not, it is Medicare fraud. Committing this violation can result in hefty consequences. 

The Center for Medicare and Medicaid Services discusses the civil penalties that one might face if found to be guilty of fraud. The exact penalty depends on the type of violation, and it may include imprisonment, fines or both. There is often an additional monetary assessment. This may be up to three times the amount of each claim or the amount of money paid, and each false claim may come with a heft penalty of up to $22,927.


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Murfreesboro Office
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